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Begin with SECTION I: APPELLANT INFORMATION. Fill in your Claimant Name, Social Security Number, and contact details including Telephone No., Fax No., and Cell Phone No. Ensure all information is accurate.
Indicate if you need a translator by selecting 'Yes' or 'No'. If 'Yes', specify the language/dialect required.
Complete your Appellant Address, ensuring to include Street No., City, State, and ZIP Code. Provide an email address for confidential communication.
In SECTION II: APPELLANT STATEMENT, clearly explain your reason for appeal. Attach additional pages if necessary, writing your name and Social Security number on each page.
Sign and date the form at the bottom before submitting it to the EDD office listed on your notice.
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